Study describes pros and cons of antidepressant use in pregnancy

Some women with depression who become pregnant face a troubling decision: whether to continue taking antidepressant medication to keep the depression at bay even though the medications may harm the fetus.

The latest on a series of studies on this issue, published Monday in the Archives of General Psychiatry, shows benefits and risks to continuing medication during pregnancy and concludes that more study is needed on the topic. As many as 6% of pregnant women take antidepressants.

Researchers in the Netherlands studied 7,696 pregnant women, which included 570 women with depression who were not on medication and 99 women with depression who were being treated with selective serotonin reuptake inhibitors (SSRIs), a common class of antidepressants.

The untreated, depressed women were more likely to have babies with reduced body growth, including reduced fetal head size, while depressed women taking SSRIs were more likely to have babies with reduced fetal head size but a normal fetal body growth. It’s unclear how significant reduced fetal head growth is. It has been linked to later behavioral and psychiatric problems in other studies.

Depression during pregnancy is, of course, difficult for the woman. In addition, depression that continues in the postpartum period may interfere with caretaking and bonding with the newborn. Thus, it may not be practical or smart to tell pregnant women to avoid SSRIs during pregnancy.

However, the risks to the fetus need to be clarified, the authors noted. “Trying to balance the possible negative consequences of untreated maternal depression with the unknown potential negative consequences of SSRIs remains an open debate,” they wrote. “Prescribing antidepressant medication to pregnant women is a major controversy in current psychiatry.”

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